1. Evidence and Practice in Drug Prevention Charli Eriksson Professor in Public Health, Director National Center for Child Health Promotion, Örebro University www.ncff.nu

2. Aims of this presentaion To clarify some key concepts Practice, Knowledge, Evidence, Evidence-based Practice, Evidence-informed Policy To outline possible development of an scientific or evidence advisory committee within ECAD

3. Ambition From belief to knowing

4. Knowledge for prevention Evidence-based interventions is needed Knowledge from controlled trials under optimal conditions ….. Knowledge is possible from different kinds of practice-based evaluations …. Reflection over practical experiences Good intentions is not enough

5. Key Concepts: Practice Addiction Addiction Drug prevention, control and treatment

6. Actions to reduce drug-related harm Infrastructures, services Legal system, administration, organizations, networks Groups, communities, population Individuals Developing services Advocacy, Networking Organizing Social mobilization Development of individual skills

7. Mechanisms of harm Toxic and other biochemical effects of drugs Psychoactive actions resulting in intoxication Dependence

8. Psychoactive Dose Pattern/volume of Dose Mode of Administration Context of use Toxic effect IntoxicationDependence Effects on fetus OverdoseInjuryInfectious disease Chronic illness Role failure Criminal punishment stigma Social reaction to use How toxic effects, intoxication, and dependence are relate to drug dose, use patterns, and mode of administration, and in turn mediate the consequences of drug use for drug user (Babor et al 2010)

9. Alcohol is not an ordinary commodity

10. Risk and Protective Factors Risk Factors Early Aggressive behavior Lack of Parental Supervision Substance Abuse Drug Availability Poverty Protective Factors Impulse Control Parental Monitoring Academic Competence Antidrug Use Policies Strong Neighborhood Attachment Domain Individual Family Peer School Community

11. What makes the psychoactive substances so symbolically powerful? Valued physical goods A social behavior with strong symbolic value Power to change behavior, mood, motor coordination, and judgment Potentially causing addiction, dependence

12. Why people use drugs The powerful ability to act on brain mechanisms that affect motivation, thinking, mood, and perhaps most importantly, the experience of pleasure Reinforcement Genetic predisposition and broader familial influences Availability

13. To develop knowledge about alcohol and drug prevention Success factors Barriers

14. What is driving the development? Traditions? Values? Needs? Knowledge? Money? …..

15. What governs the preventive policies? Ideologic inspiration Evidence Changing situation from research from experience Common sense Old Policy New policy

16. Knowledge Needs Distribution in the Population Causal web – Determinants and Mechanisms Consequences for individual and society Interventions – methods for change Policy and Implementation

17. Knowledge Plato established the main criteria for True and secure knowledge = episteme Opinion and beliefs = doxa Aristotle added two forms of practical knowledge Techne = primarily linked to handcraft and creative activity Phronesis = ethical and political life

18. Challenges To do right things = Making priorities To do things right = Having competence

19. Knowledge Theoretical-scientific knowledge = to know Practical-productive knowledge = to be able Knowledge as practical wisedom = to be wise Making PRIORITIES Having COMPETENCE

21. The Principles What helps? What hurts? Based on what evidence ? 21

22. The Evidence Concept It the amount of evidence enough for drawing conclusions in either direction? The roles for evidence, which are used in science, are systematic collection of data in an attempt to reduce bias that is inherent in more anecdotic evidence 2016-02-1722

23. Grading of Evidence Systematic review of the literature including quality assessment of research studies Hierarchies of evidence

24. Development of the Concept of Evidence The restricted interpretation – randomized studies Decision-making based on the best available evidence Practical experience – Best practice Acceptable and demanded actions in the target group

25. Evidence-based Practice Emerged in the early 1990’s from the field of medicine Requires the integration of the best research evidence with our clinical expertise and our patients’ unique values and circumstance

26. Evidence-based Practice Best Evidence Target Group Preferences and Actions Situation and Cirumstances ProfessionalExpertise (Haynes et al, 2002)

27. 1.Converting information needs related to practice decisions into well-structured questions. 2.Tracking down, with maximum efficiency, best evidence with which to answer them 3.Critically appraising that evidence for its validity, impact (size of effect) and applicability (usefulness in practice) 4.Integrate the appraisal of evidence, clinical experience and client values and preferences into practice and policy decision 5.Evaluate Steps in an Evidence-based Practice

28. For a global, evidence-informed policy International scope of problem Need for comprehensive knowledge Focus on evidence A public good perspective

29. Evidence-informed Leaves ample room for many other forces to affect public policy Democratic processes (voting), religious values, cultural norms, and social traditions can and should affect how societies respond to harmful drug use.

30. Challenged by the complexity of our dynamic reality

31. ECAD and Evidence In line with the aims of ECAD Promoting making priorities and strengthening competences for comprehensive initiatives against drug in European cities Organizing a scientific advisory committee or a committee for evidence for ECAD

32. DEVELOP KNOWLEDGE Evidence-process Collect Review Judge SHARE KNOW- LEDGE USE KNOW- LEDGE PublishImplement Plan Do Evaluate Research integrated REFLECTION

33. Bridging the Research-Practice- Policy Gaps We need: Knowledge about effective methods and tools Time and skilled personnel Leadership and administrative support Shared language concerning concepts and tools

34. Long-term drug prevention and control is possible Thank you for your attention